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Related Experiment Videos

Long-term hepatic memory for hypersensitivity to nitrofurantoin.

L A Paiva1, P J Wright, R S Koff

  • 1Department of Medicine, Framingham Union Hospital, Massachusetts.

The American Journal of Gastroenterology
|July 1, 1992
PubMed
Summary

Nitrofurantoin can cause severe liver injury, even years after initial exposure. This case highlights the danger of inadvertent rechallenge due to long-lasting hypersensitivity.

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Area of Science:

  • Hepatology
  • Pharmacology
  • Toxicology

Background:

  • Nitrofurantoin is a common antibiotic used for urinary tract infections.
  • Drug-induced liver injury (DILI) is a significant concern with various medications.
  • Nitrofurantoin-induced hepatic injury is a known but often underdiagnosed entity.

Observation:

  • A 56-year-old woman developed severe hepatocellular injury after nitrofurantoin administration.
  • This event occurred 17 years after a prior hepatitis-like illness initially attributed to infection.
  • Histological features and temporal relationship strongly suggested nitrofurantoin as the cause.

Findings:

  • The case demonstrates a remarkably long interval (17 years) between initial nitrofurantoin exposure and rechallenge-induced liver injury.

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  • Previous reports documented intervals up to 4 years, making this case exceptional.
  • The severity of the injury on rechallenge underscores the persistence of hypersensitivity.

    • Implications:

    • Failure to recognize nitrofurantoin as the cause of initial hepatitis poses significant risks.
    • Informing patients about potential drug-related hepatitis is crucial for preventing inadvertent rechallenge.
    • Hepatic hypersensitivity to nitrofurantoin can have a prolonged duration, necessitating careful patient history and drug review.